You’ve heard that oral food challenges (OFCs) are the gold standard for diagnosing food allergy, but many are fearful of undergoing the test due to the risks, which include severe reactions and anaphylaxis.
Dermatologists routinely use transepidermal water loss monitoring as a diagnostic tool, and research has shown that an increase in such water loss is a symptom of anaphylactic reactions. A team led by George Freigeh, MD, from the University of Michigan, sought to determine whether monitoring could predict the impending onset of anaphylaxis during an OFC.
They conducted a double-blind, randomized control trial to evaluate using real-time transepidermal water loss monitoring as a criterion for halting an OFC.
The study included children aged 6 months—5 years who had an allergist-confirmed diagnosis of a peanut food allergy with a prior history of reaction and peanut sensitization. Participants qualified for the trial if they had specific results following blood and skin prick tests. The researchers randomized the 40 participants into an intervention cohort of 18 children and a control arm of 22 children.
They used the following criteria to halt the OFC: increased water loss to 1g/m2 per hour or objective allergic symptoms per CoFAR criteria, whichever occurred first.
The researchers found no significant difference in reaction rate between arms, but did observe a significantly lower rate of anaphylaxis among children in the intervention arm compared with the control arm: 63% vs 100%. The children in the intervention arm also had a significantly lower rate of epinephrine use than those in the control arm: 50% vs 86%.
They concluded:
Real-time monitoring of [transepidermal water loss] during [oral food challenge] can lead to reduced anaphylaxis rates and epinephrine use, which may ultimately increase accessibility and safety of [oral food challenges].
